Healthcare Provider Details

I. General information

NPI: 1114908142
Provider Name (Legal Business Name): MICHAEL ROBERT HOFFMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 05/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

158 MILESTONE WAY
GREENVILLE SC
29615-6616
US

IV. Provider business mailing address

158 MILESTONE WAY
GREENVILLE SC
29615-6616
US

V. Phone/Fax

Practice location:
  • Phone: 864-627-4478
  • Fax: 864-627-4479
Mailing address:
  • Phone: 864-627-4478
  • Fax: 864-627-4479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number08302
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2016-00822
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: